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Request for Certificate Of Insurance

Certificate Of Insurance Request Forms

Request for Certificate Of Insurance

2014 - 2015 Policy Year

To open the request form in Microsoft Word, click on "MS Word File" to the right of your district. Fill out the form, then save and rename it (using Save As) with the rink name. You can then e-mail it as an attachment to the District Risk Manager of your district or print it out and fax or mail it. All Request For Certificate Of Insurance forms must go directly to the District Risk Manager. No other individual can sign on behalf of the District Risk Manager. You can also request forms locally by contacting your area representative.

Remember, if the rink requires that they be named as additional insured, you must forward a copy of your rink contract to your risk manager for review before the certificate can be processed.

All Request For Certificate Of Insurance forms must go directly to the District Risk Manager, with the exception of the New York District (see below). No other individual can sign on behalf of the District Risk Manager.

USA HOCKEY INLINE - A request form for a certificate of insurance is available, upon request from the USA Hockey InLine National Office at (719) 576-8724 .